ISSN0535-1405

No. 514

November 30, 2022
Published by International Medical Society of Japan,Chairman, Board of Directors: Kenichi Ishibashi, MD, PhD
Editors: K. Ito, MD, PhD, T. Kondo, MD, PhD,K. Ichihashi, MD, PhD, T. Murakami, PhD, R.Nagai, MD, PhD,
I. Taniguchi, MD, PhD, and T. Yamazaki, MD, PhD
1-11-9-3F Kamiuma, Setagaya-ku,Tokyo154-0011,Japan.
TEL 03(5486)0601 FAX 03(5486)0599 E-mail: imsj@imsj.or.jp https://www.imsj.or.jp/

The 456th International Symposium on Therapy
The 456th International Symposium on Therapy

physician, has been pointed out. Akira Tada

was held by the Zoom Webinar on September 15,

MD., Clinical director, National health insurance

2022. Dr. Ko Ichihashi, Director of the International

kuniyoshi/hasekebara clinic, who is a graduate

Medical Society of Japan (IMSJ), presided overof Jichi Medical University, has been practicing

the meeting.

efficient community medicine by making full

Medical ultrasonics-From POCUS to front-end technologyIntroductory Message from the Chairuse of ultrasound examinations. Today, he will
explain the usefulness of POCUS mainly with actual
case presentations.
Katsuro Tachibana M.D., Ph.D., Professor, Dept ofKo Ichihashi, MD, PhD
Director, IMSJ

Anatomy, Fukuoka University School of Medicine,

The theme of the 456th International Symposium

treatment for two generations. He will talk about

on Therapy has been set as "Medical ultrasonics

new world-leading technologies, starting with-From POCUS to front-end technology-". Ultrasoundthrombolysis, then microbubbles, and further

in medicine is primarily used for diagnosis.

ultrasound gene therapy using nano-bubbles.

Previously, technicians and physicians familiar withI hope that you will learn about the wide range

examinations ordered performed examinations inof usages of ultrasound in medicine by listening

physiology laboratories for detailed observations,to their lectures on the two extremes - thewhich was highly valued. Recently, however,

usefulness of ultrasound in daily medical practicethe usefulness of Point of Care Ultrasound, which

and the front-end technology of ultrasound usedis performed at the bedside by the attendingin gene therapy.

has been researching the use of ultrasound forPage 8International Medical NewsLectureⅠ
POCUS (Point of care ultrasound)spreading in- to out-of-hospital for all
the patients in Japan
Akira Tada MD．
Clinic director
National health insurance kuniyoshi/hasekebara clinic
Point of care ultrasound (POCUS) refers to ultra
sonography performed and interpreted by aclinician at the patient’s bedside.
【Differences between POCUS and comprehensive
ultrasonography】
Comprehensive ultrasonography is mainly
performed by organ-specific ultrasoundspecialists and ultrasound technologists using
high-performance ultrasound equipment
installed in ultrasound examination rooms．
POCUS, on the other hand, is a quick ultrasoundexamination performed at the bedside by aclinician focusing on findings necessary for
diagnosis or treatment. For this purpose, theultrasound device used in POCUS should besmall and portable.
【POCUS development】
The earliest POCUS protocol was FAST (focusedassessment with sonography for trauma) for
intra-abdominal hemorrhage following blunttrauma.
Since then, POCUS protocols have beendeveloped and utilized in clinical practice.
POCUS was initially developed for use inemergency departments and hospitals, andhas since been used in a wide range of settings,【The evolution of hand-held ultrasound devices】
Furthermore, POCUS has progressed along with theevolution of portable ultrasound devices.
The improved portability of POCUS due to its
smaller size allows for ultrasound examinations at
any location, and the improved image quality has
led to a variety of applications.
In addition, the ICT function of the ultrasounddevice itself facilitates information sharing withcolleagues and supervisors and makes it easier
to consult with patients in and out of the hospitaland at home．
These technological advances are changing
home care as well as emergency medicine.
As of 2022, there will be more than 800,000
patients in home care in Japan, and thenumber is increasing every year. Although there
are limitations on the tests and treatments inhome healthcare, the use of POCUS has greatly
expanded the possibilities.
On the other hand, in home healthcare, it isdifficult to perform POCUS on all indicated patients
due to the lack of manpower of physicians.
Therefore, home-visiting nurses are expected tobe the POCUS providers. They are regularly involvedin the medical and nursing care of patients athome and can more closely assess patients’changes.
The benefits of using POCUS for home-visiting
nurses are as follows. The visualization of patientcomplaints provides reassurance to both patientsand health care providers, and the use ofultrasound images facilitates the communicationof information between professions.

including disaster situations and home care.

【The issues of POCUS】

In recent years, the multifaceted use of POCUS

First, there are some barriers to evidence

in COVID-19 has also attracted attention. Whilecreation.

there are limitations in the use of imaging tests

Although data on the efficiency and economics

with droplet and contact infection prevention,of POCUS are increasing, data on patient

POCUS, which is easy to perform in the field,

outcomes are still insufficient. On the othercan be used to detect pneumonia, myocarditis,

hand, the variation in skill levels of clinicians

and thromboembolism, which are serious

performing POCUS and the difficulty ofcomplications of COVID-19, as well as for respiratory

standardizing scanning protocols are barriers

management and transfusion management.

to clinical research and are issues to be

Page 9International Medical News

addressed in the future.

attracted much attention. The word “nanobubble”
is officially termed by ISO as “ultrafine bubble” andNext is the issue of the payment system for POCUS.

defined as bubbles smaller than 1 micrometer.

Concerning medical fees, POCUS is partiallyFew studies have evaluated the effect of

distinguished from comprehensive ultrasonography

different NB size distribution to the efficiency

in home healthcare in Japan, but in hospitals,of gene delivery into cells. We studied, variousthere is no distinction between them.

size of albumin stabilized sub-micron bubbles

In addition, POCUS performed by visiting nurses

and examined in an in vitro ultrasound irradiation

is currently not reimbursed, which is an obstacle

setup in the aim to compare and optimize geneto its widespread use.

transfer efficiency (1). Results with pDNA showedThus, for POCUS to be widely utilized in the future,significant increase of gene transfer efficiency

it is considered necessary to establish a payment

in the presence of NB. Similarly, carrier-freesystem.

mRNA transfer efficiency increased in the sameconditions. It is suggested that NB size contributed

Thirdly, educational opportunities should be

more to the delivery of genes into the cytoplasm

secured under the SARS-CoV-2 epidemic.

with ultrasound. Although further experiments are

The most desirable learning for POCUS is hands-

needed to understand the underlying mechanism

on training, in which participants hold the probe

for this phenomenon, the present results offer

and receive instruction, rather than just listening

valuable information in optimizing of NB for future

to lectures.

ultrasound-mediate gene therapy. In addition,

On the other hand, the number of hands-

our experiments suggests that lower ultrasoundon seminars rapidly declined after the SARS-

intensity can be used to induce gene transfer

CoV-2 epidemic, and securing educational

thus opening possibility of miniaturization of theopportunities became an urgent issue. In response

ultrasound device. In the future, hand-held, battery

to this problem, online lectures, remote live

powered, portable ultrasound gene “injectors”

demonstrations, and hands-on activities are

may be used for gene vaccines and for various

gradually increasing by utilizing ICT devices.

cancer therapy.

The search is on for more effective educational
methods, combining traditional and new1) Kida H, Feril LB, Irie Y, Endo H, Itaka K andeducational methods.

Tachibana K (2022) Influence of Nanobubble
Size Distribution on Ultrasound-Mediated Plasmid
DNA and Messenger RNA Gene Delivery.

LectureⅡ
New horizons in ultrasound genetherapy with nanobubbles
Katsura Tachibana, MD. Ph.D.
Professor, Dept of Anatomy
Fukuoka University School of Medicine
Gene therapy has been intensively investigatedas a new treatment for various cancers as well
as for rare diseases. Therapeutic genetic materials
such as DNA or RNA are required to reach thetarget cells in sufficient quantities to yield beneficial
outcome. The use of nanobubbles (NBs) for
ultrasound-mediated gene therapy has recentlyFront. Pharmacol. 13:855495. doi: 10.3389/
fphar.2022.855495

Discourse
Introduction of the speaker of discourse
Ko Ichihashi, MD, PhD
Director, IMSJPianist and music producer Hiroo Hadame will
give us a lecture titled "Music is a Flower that
Blooms with Time”. Mr. Hadame’s broad-ranging
and unique activities include the planning andproducing of Italian operas, classical concerts,and others in Noh theaters, shrines, temples, andPage 10International Medical News

rural settings, as well as the teaching of posture

close the vocal folds and place them on theand glottal movements through scientific analysis

exhaled breath, but when singing, the amountinside and outside Japan. He is going to introduce

and timing of the inhaled breath can affect thesome of his activities, and also going to use his own

following expression.

piano performance and beautiful voice to make

When adding language to this mix, the modulation

his lecture easy-to-understand for us. Please lookof consonants and vowels when singing in a

forward to his lecture.

language other than one's native tongue is quite
impregnable and requires technique. Therefore,

Discourse: Music is a Flower that Blooms
with Time
Hiroo Hadameleads to cultivating the perception and acting
ability to instantly bloom, from conscious to theunconscious.

Pianist, Music producer

At the School of Liberal Arts, to which I belong to,I cannot thank you enough for giving me thisalthough Liberal Arts is the foundation, few students

wonderful opportunity!

have a deep understanding of the seven liberal

I feel as if my long-standing science complex has

arts (astronomy, arithmetic, geometry, rhetoric,

been lifted.

grammar, music, and philosophy) that have been
advocated since Plato's Academia, and many

Now, as a musician myself, I would like to talk a

simply think that it is enough to have a broad or

little about music and language, and the necessity

shallow knowledge or have in-depth knowledge.

of music in a liberal arts context.

The understanding of why music (perception) was
needed from that time period has become an out

In recent days, the word “diversity” has becomeof interest for many.

a key word in our society. In Japanese, this word
is translated as 多様性 (groups with widely differing

When talking about music, it can be said thatproperties co-existing). But in the case of Italy, formusic cannot be spoken or sung unless all of theexample, the word "different" is not used very often

following are in place: phenomenological soundin everyday life, but rather use the word "Diverso"= astronomy, harmonic arrangement = arithmetic,(noun form Diversità). In other words, “A” and “B”

graphic interpretation of musical notation =are different.

geometry, rhetoric as its underlying grammar, how

If I had been able to substitute numbers so that

it is sung and its expression as rhetoric.

A=B, I would have gone into the science field.

In addition, when performing, the probabilityof being moved by the performance depends

When talking about vocal music education,on the instantaneous perception of spaceunlike piano and violin, the instrument is inside(environment, score), time (notes, beats, measures,

the body and is difficult to visualize, so numbers

or shared performance time), force (emotional anddo not intervene in instruction but rather emotion

physical coefficient of diversity between oneself

and experience becomes the key in instruction

and the composer), and direction (the entire

throughout history.

space or an audience in a particular direction),

The reality is that medical and scientific guidanceas initial settings before any esoteric philosophy.

on the differences in skeletal structure between

In other words, it is necessary to think thoroughly

A and B, muscle strength, posture, vocal cord

about one's own stature, position, and location

mechanisms, diaphragm function, angles,

from a cultural fixed point, and have thelanguage frequencies and sound movement is notknowledge and education to quickly derive

mainstreamed in the teaching field.

the center (solution to the problem), and music
is to be done after covering all of these bases.

Focusing on the voice, during vocalization, weFor example, in my field, opera singers werePage 11

originally known as the well-rounded, cultured, andeducated that even the presidents would bow
down to them.
I have interacted with opera singers, conductors,and others in the field, mainly in Italy, and while
I enjoy the excitement of star singers in costume,
performing traditional operas, the more I meetthe masters of this art form, the more I feel theimportance of "Human being as a collective art”
in the sense that Opera = Opus (Latin) = work.
Therefore, for a musician, in order to become
an expressive person who can attract not only
a limited audience but also people from othergenres, one must consciously and physicallymanipulate the body, become "empty" andreceive the energy of the subject (in classicalmusic, the musical score). Once getting the senseof "emptiness", then "color" should be added andtransmitted to the space and the object. Becauseof this, I have struggled with my spine flexing andreceiving too much.
But now that I have been involved in both polesof Japanese "nodding culture" and Western"horizontal culture," I think I finally understand how
to transmit in my way.
Now that my mother, who used to love Gymnaster(miyakowasure), is in need of nursing care and is
now like Edelweiss, every day is full of surprises.
Whether it be water lilies or daffodils, violets
or dandelions, even if we encounter each otherin different environments, sometimes under
extremely different circumstances, I would liketo see a development where we can better eachother, understanding the stature and thoughtsof the counterpart.
Maintaining status quo is decline!
Grazie!

International Medical News